结直肠癌患者手术切口感染危险因素的Meta分析

doi:10.16460/j.issn1008-9969.2021.08.023

摘要/Abstract

摘要： 目的通过Meta分析探讨结直肠癌患者手术切口感染的危险因素,为制定预防措施提供参考依据。方法计算机检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、The Cochrane Library、PubMed、Embase、Web of Science数据库,收集关于结直肠癌手术切口感染危险因素的病例对照研究和队列研究。由2名研究者根据纳入与排除标准进行文献筛选,并运用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale,NOS）对纳入文献进行质量评价。结果最终纳入17篇文献,累计结肠癌患者16 992例。Meta分析结果显示糖尿病（OR=1.65,95%CI:1.48~1.84）、手术时间≥3 h（OR=1.41,95%CI:1.22~1.63）、体质量指数（Body Mass Index, BMI）≧30 kg/m²（OR=1.35,95%CI:1.18~1.55）、开腹手术（OR=1.60,95%CI:1.23~2.07）、手术方式（OR=1.69,95%CI:1.38~2.08）、肿瘤分期（OR=1.42,95%CI:1.28~1.58）、年龄（OR=1.28,95%CI:1.12~1.47）为结直肠癌患者手术切口感染的危险因素。敏感性分析与发表偏倚结果显示各因素合并结果比较稳定,发表偏倚不明显。结论对结直肠癌患者基础疾病、手术时间、体质量、手术方式、肿瘤分期及年龄等进行管理可有效降低手术切口感染的发生率。

关键词: 结直肠癌, 手术切口, 感染, Meta分析

Abstract: Objective To clarify the risk factors of surgical incision infection in patients with colorectal cancer through meta-analysis, and to provide reference for preventive measures. Methods Case-control studies and cohort studies on risk factors of surgical incision infection in patients with colorectal cancer were searched in databases including CNKI, China Biomedical Literature Database, Wanfang Database, Weipu Database, The Cochrane Library, PubMed, Embase, and Web of Science. Two researchers screened the literature according to the inclusion and exclusion criteria, and evaluated the quality of the included literature by Newcastle-Ottawa Scale(NOS). RevMan5.3 was used to perform statistical analysis. Results Seventeen articles were finally included, with a total of 16,992 cases of colon cancer, and 8 risk factors. Meta-analysis showed that diabetes (OR=1.65, 95%CI: 1.48~1.84), operation time (OR=1.41, 95%CI: 1.22~1.63), BMI (OR=1.35, 95%CI: 1.18~1.55), open surgery (OR=1.60, 95%CI: 1.23~2.07), surgical method (OR=1.69, 95%CI: 1.38~2.08), tumor stage (OR=1.42, 95%CI: 1.28~1.58) , and age (OR=1.28, 95%CI: 1.12~1.47) were risk factors for surgical incision infection in patients with colorectal cancer. Sensitivity analysis and publication bias results show that the combined results of all factors were relatively stable, and no obvious publication bias was found. Conclusion Effective management for basic disease, operation time, weight, open surgery, operation method, tumor stage and age can effectively reduce the incidence of surgical incision infection.

Key words: colorectal cancer, surgical incision, infection, Meta-analysis

中图分类号:

R473.57

胡正中, 廖园园, 周毅峰, 彭瑨, 秦月兰. 结直肠癌患者手术切口感染危险因素的Meta分析[J]. 护理学报, 2021, 28(8): 23-27.

HU Zheng-zhong, LIAO Yuan-yuan, ZHOU Yi-feng, PENG Jin, QIN Yue-lan. Risk Factors for Surgical Incision Infection in Patients with Colorectal Cancer: A Meta-analysis[J]. Journal of Nursing, 2021, 28(8): 23-27.

参考文献

[1] Chen J, Miller M, Ibele A,et al.Dual Ring Wound Protector Reduces Circular Stapler Related Surgical Site Infections in Patients Undergoing Laparoscopic Roux-En-Y Gastric Bypass[J]. Obes Surg, 2018,28(10):3352-3359. DOI:10.1007/s11695-018-3394-6.
[2] Darling JD, McCallum JC, Soden PA, et al.Predictive ability of the Society for Vascular Surgery Wound,Ischemia,and foot Infection(WIfI) Classification System Following Infrapopliteal Endovascular Interventions for Critical Limb Ischemia[J]. Vasc Surg, 2016,64(3):616-622. DOI:10.1016/j.jvs.2016.03.417.
[3] 汪青,王雨,方俊,等.结直肠癌患者手术部位感染的病原菌分析[J].中华医院感染学杂志,2016, 26(13):2930-2932. DOI:10.11816/cn.ni.2016-153694.
[4] 彭联明,蔡晶晶,何亚光,等.术中冲洗液在结直肠癌术后切口感染预防中的应用[J].中国内镜杂志,2017,23(8):18-22. DOI:10.3969/j.issn.1007-1989.2017.08.004.
[5] 王樱,陈川丽,吴同丽,等.结直肠癌手术部位感染危险因素及预测模型[J/OL].中华医院感染学杂志,2021(5):663-667[2021-03-22].
[6] 陈定超,李彦,李建胜,等.结直肠癌患者手术部位感染相关因素分析[J].中华医院感染学杂志, 2018, 28(12):1856-1859.DOI:10.11816/cn.ni.2018-171819.
[7] Amri R, Dinaux AM, Kunitake H, et al.Risk Stratification for Surgical Site Infections in Colon Cancer[J]. JAMA Surg, 2017,152(7):686-690. DOI:10.1001/jamasurg.2017.0505.
[8] 庞艳,林芳初,李嫒,等.产后尿潴留发病危险因素Meta分析[J].护理学报,2020, 27(20):1-6.DOI:10.16460/j.issn1008-9969.2020.20.001.
[9] 熊璨,高兴莲,向御婷,等.成人手术患者术中低体温影响因素的Meta分析[J].护理学报,2018, 25(2):48-53.DOI:10.16460/j.issn1008-9969.2018.02.048.
[10] 沈忠,裘建明,杨关根,等.结直肠癌患者术后切口感染相关危险因素分析[J].中华医院感染学杂志, 2014, 24(13):3286-3287+3295. DOI:10.11816/cn.ni.2014-130820.
[11] 马燕,杨秀英,黄春燕等.结直肠癌术后切口感染相关危险因素分析[J].中华医院感染学杂志,2014, 24(17):4309-4311. DOI:10.11816/cn.ni.2014-131878.
[12] 郑晖. 结直肠癌患者手术部位切口感染的危险因素分析[D]. 福州:福建医科大学,2014.
[13] 杨玉波,关铁军,王斌,等.直肠癌手术切口感染的危险因素分析与预防对策[J].中华医院感染学杂志, 2015,25(1):183-185. DOI:10.11816/cn.ni.2015-132609.
[14] RencüZogulları A, Trunzo JA, Vogel JD, et al. Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-risk Patients Increases the Efficacy of Prevention Bundles[J]. Turkish Journal of Colorectal Disease, 2017, 28(1).DOI:10.4274/tjcd.82474.
[15] Biondo S, Kreisler E, Fraccalvieri D, et al.Risk Factors for Surgical Site Infection after Elective Resection for Rectal Cancer. A Multivariate Analysis on 2131 Patients[J]. Colorectal Dis, 2012,14(3):e95-e102.DOI:10.1111/j.1463-1318.2011.02798.x.
[16] Bot J, Piessen G, Robb WB, et al.Advanced Tumor Stage Is an Independent Risk Factor of Postoperative Infectious Complications after Colorectal Surgery: Arguments from a Case-matched Series[J]. Dis Colon Rectum, 2013,56(5):568-576.DOI:10.1097/DCR.0b013e318282e790.PMID: 23575395.
[17] Cima RR, Bergquist JR, Hanson KT, et al.Outcomes Are Local: Patient, Disease, and Procedure-specific Risk Factors for Colorectal Surgical Site Infections from a Single Institution[J].Gastrointest Surg, 2017,21(7):1142-1152. DOI: 10.1007/s11605-017-3430-1.
[18] Crombe T, Bot J, Messager M, et al.Malignancy Is a Risk Factor for Postoperative Infectious Complications after Elective Colorectal Resection[J]. Int J Colorectal Dis,2016,31(4):885-894. DOI: 10.1007/s00384-016-2521-x.
[19] Hibbert D, Abduljabbar AS, Alhomoud SJ, et al.Risk Factors for Abdominal Incision Infection after Colorectal Surgery in a Saudi Arabian Population: The Method of Surveillance Matters[J]. Surg Infect (Larchmt), 2015,16(3):254-262. DOI:10.1089/sur.2013.208.
[20] Ishikawa K, Kusumi T, Hosokawa M, et al.Incisional Surgical Site Infection after Elective Open Surgery for Colorectal Cancer[J]. Int J Surg Oncol, 2014,2014:419712. DOI:10.1155/2014/419712. Epub 2014 Mar 27.
[21] Silvestri M, Dobrinja C, Scomersi S, et al.Modifiable and Non-modifiable Risk Factors for Surgical Site Infection after Colorectal Surgery: A Single-center Experience[J].Surg Today, 2018,48(3):338-345. DOI:10.1007/s00595-017-1590-y.
[22] Itatsu K, Sugawara G, Kaneoka Y, et al.Risk Factors for Incisional Surgical Site Infections in Elective Surgery for Colorectal Cancer:Focus on Intraoperative Meticulous Wound Management[J]. Surg Today, 2014,44(7):1242-1252. DOI: 10.1007/s00595-013-0677-3.
[23] 马骏,张兴,王园园,等.结直肠癌患者术后切口感染危险因素分析[J].中华肿瘤防治杂志,2020,27(5):382-385. DOI:10.16073/j.cnki.cjcpt.2020.05.09.
[24] 吴莺燕,吴婧,江金燕,等.结直肠癌患者术后切口感染的相关因素分析及护理干预研究[J]. 中华医院感染学杂志,2018,28(13):2005-2008.DOI:10.11816/cn.ni.2018-172208.
[25] 蔡尚党,张龙江,王海颖,等.结直肠癌患者手术部位感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2016,26(4):862-864. DOI:10.11816/cn.ni.2016-152926.
[26] 刘源炜,陈必成,陈杰,等.结肠癌根治术患者术后切口感染病原菌及影响因素分析[J].中华医院感染学杂志,2018,28(15):2341-2344. DOI:10.11816/cn.ni.2018-173279.
[27] Wukich DK, McMillen RL,Lowery NJ,et al. Surgical Site Infections after Foot and Ankle Surgery: A Comparison of Patients with and without Diabetes[J]. Diabetes care,2011,34(10).DOI:10.2337/dc11-0846.
[28] Wang W, Peng G, Guo Z, et al.Radical Resection of Right Upper Lung Cancer Using Uniportal Video-assisted Thoracic Surgery with Non-intubated Anesthesia[J]. Thorac Dis, 2015,7(12):2362-2365.DOI:10.3978/j.issn.2072-1439.2015.12.51.
[29] 张娟,李洁,周超熙,等.结肠癌术后切口感染的影响因素分析[J].中国病原生物学杂志,2015,10(12):1140-1143. DOI:10.13350/j.cjpb.151219.
[30] Katsuno G, Fukunaga M, Nagakari K, et al.Short-term and Long-term Outcomes of Single-incision Versus Multi-incision Laparoscopic Resection for Colorectal Cancer : A Propensity-score-matched Analysis of 214 Cases[J].Surgical Endoscopy,2016,30(4). DOI:10.1007/s00464-015-4371-y.
[31] 先疆燕. 结直肠癌手术部位感染危险因素分析[D]. 石河子:石河子大学,2016.
[32] Hirao M, Tsujinaka T, Imamura H, et al.Overweight Is a Risk Factor for Surgical Site Infection Following Distal Gastrectomy for Gastric Cancer[J]. Gastric Cancer,2013,16(2). DOI:10.1007/s10120-012-0174-1.
[33] 陈燕,彭伟.细胞免疫功能和炎性因子在结直肠癌患者根治术后并发切口感染中的价值研究[J].现代消化及介入诊疗,2019,24(2):158-161. DOI:10.3969/j.issn.1672-2159.2019.02.012.
[34] 姚银春,姚娅.加速康复外科在老年腹腔镜结直肠癌手术中应用的Meta分析[J].现代医药卫生,2019,35(16):2466-2469. DOI:CNKI:SUN:XYWS.0.2019-16-013.
[35] Murray AC, Pasam R, Estrada D, et al.Risk of Surgical Site Infection Varies Based on Location of Disease and Segment of Colorectal Resection for Cancer[J]. Dis Colon Rectum,2016,59(6):493-500.DOI:10.1097/DCR.0000000000000577.
[36] 牛学瑞,张云昌,张叶广.老年患者行腹腔镜下结直肠癌手术并发症的预防及处理[J].现代仪器与医疗,2018,24(1):50-52. DOI:10.11876/mimt201801020.
[37] 刘晓亮. 结直肠癌术后表浅手术切口感染的影响因素分析[J].广西医科大学学报,2018,35(1):65-67.

相关文章 15

[1]	张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[2]	李疆伟, 王树君, 李长仔, 胡宝山, 焦桂梅, 张卫红. 基于压力应对理论的护理干预对结直肠癌术后永久性肠造口患者心理压力、负性情绪及自我管理的影响[J]. 护理学报, 2025, 32(4): 64-69.
[3]	曹敏, 张培莉, 侯晓雅, 高超越, 郭林芳, 李滢. ABC-X模型下结直肠癌化疗患者照顾者营养照护体验的质性研究[J]. 护理学报, 2025, 32(2): 13-18.
[4]	姚婉晴, 杨立状, 陈旦旦, 张晚秋, 卢薇, 管翠红, 李海. 不同非药物干预措施改善乳腺癌患者疲乏效果的网状Meta分析[J]. 护理学报, 2024, 31(24): 37-43.
[5]	周春香, 饶媛, 崔梦娇, 商芷颖, 张天岚, 裘奚晨卉, 秦艳萍. 基于传感器技术的智能康复设备在脑卒中患者步态康复应用效果的Meta分析[J]. 护理学报, 2024, 31(24): 44-50.
[6]	戴倩, 刘翔宇, 朱小妹, 王佳丽, 黄远思. 结直肠癌造口患者自我同情现状及影响因素研究[J]. 护理学报, 2024, 31(23): 13-17.
[7]	章明阳, 刘京辉, 金雁, 徐文琪, 李斌飞, 黄珊, 杜李百合, 侯亚甜, 李小寒. 围手术期低体温风险预测模型的系统评价[J]. 护理学报, 2024, 31(22): 54-60.
[8]	胡杏娟, 张伦, 高钰琳, 高春凤, 陈妙燕, 李晓君, 陈烯琳, 洪笃云, 梁业基. 生成式人工智能辅助混合式教学在实习护生皮内针技术感染预防教学中的应用[J]. 护理学报, 2024, 31(18): 21-25.
[9]	罗海琴, 谢日华, 梁绰意. 正念干预对不孕症女性心理健康和生活质量影响的Meta分析[J]. 护理学报, 2024, 31(17): 28-34.
[10]	梁琪, 王冰洁, 刘洋, 张春梅. 智谋在老年结直肠癌造口患者病耻感与社会隔离的中介效应[J]. 护理学报, 2024, 31(14): 19-23.
[11]	黄子菁, 王颖, 朱丽, 马婉秋, 杜玫洁, 崔梦影, 蔡悦, 张昕悦, 陈敏, 鲁志卉. 胃肠道肿瘤患者术前口服营养补充指南的质量评价及内容分析[J]. 护理学报, 2024, 31(11): 42-47.
[12]	廖雨风, 牛耿, 罗群, 阮宏兵, 汪欢, 徐佳卿, 杜艳丽. BOPPPS联合情境模拟法在培养护生院感防控能力中的应用[J]. 护理学报, 2024, 31(10): 17-20.
[13]	黄丽华, 翟巾帼, 田金徽, 孔淦霞, 王雪岩, 陈莉瑾, 袁心愿, 耿薪茜, 陈昭桐. 妊娠期生活方式干预对妊娠期高血压疾病进展及母婴结局影响的Meta分析[J]. 护理学报, 2023, 30(24): 38-42.
[14]	孙菲, 刘敏, 胡珊珊, 吴蕾, 刘君, 李萍. 基于Meta分析构建早产儿母亲泌乳建立风险预测评分模型[J]. 护理学报, 2023, 30(23): 1-5.
[15]	王多, 乔秋阁, 刘茹茹, 张妹英, 李亚伟, 高克娜, 高翠, 史蕾, 王文耀. 基于IMB模型结直肠癌术后居家患者经口营养管理的最佳证据总结[J]. 护理学报, 2023, 30(23): 50-56.

Metrics

Viewed

Full text

Abstract

Cited

Shared